Provider Demographics
NPI:1881912533
Name:CAPITOL MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:CAPITOL MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KENYON
Authorized Official - Last Name:DUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-410-4800
Mailing Address - Street 1:2323 CURLEW RD
Mailing Address - Street 2:SUITE 7-E
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9330
Mailing Address - Country:US
Mailing Address - Phone:877-855-4206
Mailing Address - Fax:727-216-6283
Practice Address - Street 1:2323 CURLEW RD
Practice Address - Street 2:SUITE 7-E
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9330
Practice Address - Country:US
Practice Address - Phone:877-815-4206
Practice Address - Fax:727-216-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6429550001Medicare NSC